Nurses fear single room-only hospitals risk damaging patient safety and team work, but patients generally prefer having their own room, according to latest analysis.
Increasingly, new hospital design includes greater proportions of single room accommodation and in some cases all single inpatient rooms, highlighted the authors of the research.
The first NHS hospital in England to have 100% single in-patient rooms in all wards and high-acuity areas opened near Tunbridge Wells in Kent during 2011.
Their study, published online by the National Institute for Health Research, examined the impact of moving from large bays and traditional “Nightingale-style” wards to 100% single room accommodation at the new Tunbridge Wells Hospital in Pembury.
The two-year project considered the views of staff and patients before and after the move to the new, purpose-built hospital where every room has a single bed and en suite bathroom.
They found high levels of anxiety among nursing staff trying to adapt to the new working environment. While nurses could see the benefits of single rooms when it came to privacy, confidentiality and for visitors, they also flagged up a range of issues.
Key concerns included difficulty in monitoring patients, especially when it came to keeping an eye on those at risk of falls, though the researchers found no clear evidence that patient safety had been affected.
Staff also found it harder to find each other and said they had less contact with colleagues, so it was more difficult to observe other people’s work, share ideas or ask for help.
Nurses were asked their opinion at different points during the study, which involved researchers from the National Nursing Research Unit at King’s College London, Southampton University and Imperial College Business School.
Each time, less than 18% of staff said they preferred 100% single rooms, with most saying they would rather have a combination of beds in single rooms and in bays.
Sixty-two per cent of respondents in the staff survey felt the response to calls was worse in single-bedded rooms. Ratings of teamwork, handovers and communication between different healthcare professions were lower after the move.
“Nurses found it difficult to monitor multiple patients as they didn’t have a line of sight across a bay of beds”
Nurses also reported feeling “pulled” and that they were not able to spend as much as they wanted with some patients, or alternatively getting “stuck” in one room when they needed to be elsewhere.
In contrast, the majority of patients were in favour of single rooms, reporting they were more comfortable, less noisy and that it was easier to get to sleep.
Lead study author Professor Jill Maben, director of the NNRU at King’s, said the research painted a mixed picture of the advantages and disadvantages of 100% single occupancy facilities.
“On the one had we have seen improved patients experience because of benefits such as privacy and noise reduction while on the other some patients have reported feeling isolated or lonely,” she said.
“For staff the picture is even more complex,” she said. “Nurses found it difficult to monitor multiple patients as they didn’t have a line of sight across a bay of beds and this was especially important for older vulnerable patients at risk of falling.”
The report suggested that training and rehearsing new ways of working before making a shift to single room working could help improve the experiences of both patients and staff.
What do you think of single-room wards?
Would you prefer this way of working? What advantages and disadvantages could this ward structure present?
At 1pm today (Wednesday 8 April) we’re going to be hosting a live discussion on Twitter. To join in simply search for #NTtwitchat and use this hashtag in all your tweets.